“Openly welcoming a preordained veto, Republicans drove legislation to Senate passage Thursday aimed at crippling two of their favorite targets: President Barack Obama’s health care law and Planned Parenthood,” the AP reports.

“With a House rubber stamp expected in days, the bill would be the first to reach Obama’s desk demolishing his 2010 health care overhaul, one of his proudest domestic achievements, and halting federal payments to Planned Parenthood. Congress has voted dozens of times to repeal or weaken the health law and several times against Planned Parenthood’s funding, but until now Democrats thwarted Republicans from shipping the legislation to the White House.”

However, there's also some very positive news to report. 5 other major insurers have told UnitedHealthcare to chill out. Enrollments are chugging along nicely (HC.gov should have broken the 2 million mark on Saturday, and nationally we should be up to around 2.6 million). The exchange websites seem to be working smoothly across the board (or at least, if there've been any significant technical problems, I've yet to hear about them).

I've watched the original Star Wars trilogy countless times, but ever since my kid was born, every time I watch something catches my eye which I never noticed (or noticed but didn't think about) before.

So, my 9-year old and I are watching "Return of the Jedi" again today (in anticipation of The Force Awakens, of course). In an early scene in Jabba's palace, Princess Leia is sneaking around at night, in the dark, trying to remain undetected so she can free Han Solo from the Carbonite, right? So what does she immediately do?

She bumps head first into a large wind chime which is inexplicably hanging in the stairwell.

There's a lot of news stories of late about Colorado activists managing to successfully place a statewide initiative on the 2016 ballot which, if successful, would make Colorado the first state to move to a new Single Payer healthcare model.

I haven't written a whole lot about this so far, partly because we're still a year out, partly because I'm swamped with current Open Enrollment Period developments (believe me, I'll have more to say about it after the end of #OE3).

However, there's one meme which keeps coming up in the news which drives me a bit insane:

Hmmmm...over at Investor's Business Daily, Jed Graham looks at HealthCare.Gov's 3rd Weekly Snapshot report from a different angle: If you set aside renewals of current enrollees, how are things looking in terms of new additions?

As I noted in my detailed 2016 OE3 projection breakdown, nationally the HHS Dept. is projecting around 8.1 million renewals, plus around 4.5 million new additions, for a total of roughly 12.6 million QHP selections (expected to then dwindle down to roughly 10.0 million still enrolled/paying by the end of next year. In contrast, I'm more optimistic: I projected around 9.0 million renewals, plus 5.7 million new additions.

Ever since I posted my latest article on the growing Individual Mandate Penalty (again, it's up to $695 per person or 2.5% of household income this year), I've heard the same response from many ACA detractors (and even some supporters): Even with the increase in the mandate penalty (technically, it's called the "Individual Shared Responsibility Payment"), it's still too small for it to make sense economically for most people when compared to the cost of enrolling in a compliant policy.

Even with tax credits, the reasoning goes, even the least-expensive Bronze plan (or Catastrophic for those who qualify) is still more expensive than the mandate tax. Of course, if you pay the penalty, then you're still stuck with absolutely no insurance whatsoever, whereas if you enroll in even a basic Bronze plan, you're at least covered for major medical expenses (ie, the type which can wipe out even a $10K deductible*), while also receiving many basic medical treatments like checkups, immunizations and cancer screenings at no charge or for a nominal co-pay. However, it's true that in some cases, the up front dollars paid are indeed higher for the policy than the fee.

*UPDATE: D'oh! Thanks to Esther Ferington for reminding me that the actual worst-case scenario might not be nearly as bad as this, due to the ACA's limit on total out of pocket maximums. For instance, a single, non-smoking 26-year old in Detroit making $20K/year would have an out-of-pocket maximum of $6,450 no matter how much they rack up in medical expenses. On the one hand, that'd still be a disaster on $20K/year. On the other hand, it's also still a lot better than $10K...not to mention the $100K+ which the expenses might rack up without any insurance at all).

Of course, much of this is subjective and, due to the very nature of insurance itself, inherently relies on unknowns. After all, if you knew for certain that you'll never need any medical treatment whatsoever over the next 12 months, paying anything for health insurance would technically be a waste of money. On the other hand, if you know for certain that you're going to rack up a million dollars in medical expenses next year, pretty much any ACA-compliant policy would still be money well spent. Unfortunately, no one knows one or the other for certain, which is kind of the point of insurance in the first place.

I cannot stress this point enough: I am in no way advocating that anyone NOT enroll. I'm basically just playing Devil's Advocate here as a thinking exercise.

As of Nov. 23, 19,675 Marylanders had enrolled in private coverage with some or most of their premium costs next year to be offset by advance tax credits. Another 5,310 enrolled in qualified health plans without tax credits. Nearly 72 percent, or 17,960, were enrolled in SIlver plans.

That's 24,985 QHPs total in 23 days, or 1,086 per day.

In addition, 1,708 people have enrolled in stand-alone dental plans and 5,235 more have enrolled in dental along with health coverage for a total of 6,943 with dental coverage next year.

Also, 87,941 were enrolled in Medicaid since Nov. 1 through Maryland Health Connection.

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Three is no diffferent:

PROVIDENCE – HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, November 21, 2015, for Open Enrollment.

INDIVIDUAL AND FAMILY ENROLLMENT As of November 21, 2015:

31,012 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.

Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan. 920 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

Last year, during the third week of Open Enrollment, 618,548 people selected QHPs via the federal exchange (HealthCare.Gov). This year, I'm pretty sure that right around 500,000 people selected QHPs during the third week.

During the third week of Open Enrollment, consumers continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or visitingHealthCare.gov or CuidadoDeSalud.gov. There are about three weeks remaining ahead of the December 15 deadline.

Views on Obamacare have taken a negative shift, according to a November Kaiser Family Foundation poll released Tuesday.

Forty-five percent of Americans now say they have a negative view of the Affordable Care Act, while 38 percent have a positive view. This represents a reversal from earlier this year when, for the first time in three years, a greater number of Americans were in favor of the law than against it.

In October, a KFF poll found opinion evenly split on the law at 42 percent. The foundation's September poll showed a more narrow divide, with a 41 percent favorable to 45 percent unfavorable rating. A KFF survey conducted in August showed opinion skewed more favorably, with 44 percent of Americans stating they had a positive view and 41 percent stating they had a negative one.

I am working on an article about UnitedHealth Group saying it may drop out of Affordable Care Act exchanges in 2017. I am trying to get a sense of how significant this and other recent news surrounding the law really are. I see you have written several posts about these developments. If you are interested and available to talk about that on the phone for a few minutes today, please let me know. Thank you.

However, here's what you have to keep in mind: The first week was 17% higher this year than last (543K vs. 462K). The second week was a whopping 77% higher than last year! (535K vs. 303K).

Why the massive discrepancies? Simple: The calendar. Last year, Open Enrollment started on November 15th. The second week was also Thanksgiving week, which meant that enrollments dropped off to practically zilch for that Thursday and Friday.

This year, Open Enrollment started 2 weeks earlier, on November 1st. That means two important differences:

U.S. adults are slightly more likely to say it is the responsibility of the federal government to ensure all Americans have health insurance coverage (51%) than to say it is not the government's responsibility (47%). The percentage who believe the government has that obligation is up six percentage points from 2014. This year marks the first time since 2008 that a majority of Americans say the government is responsible for making sure all citizens have health insurance.

In short: UHC sat out the ACA exchanges in 2014, dove into half the states head first for 2015, expanded into another 11 states for 2016...but then suddenly announced that they "may" drop out of the exchanges completely in 2017? Furthermore, they made this announcement a month after painting a glowing outlook in their official quarterly report and did so in the middle of the 2016 open enrollment period? Something doesn't sound right here.

Over at Inside Health Policy, Amy Lotven takes a deeper look at one part of last week's UnitedHealthcare announcement which slipped by a lot of people:

United Notes Customer Churn As It Mulls Exiting Exchanges

...United in a Thursday morning call said it is seeing a high number of people who are purchasing exchange plans, receiving services, and then dropping their policies. Aetna, which last month announced it would scale back its offerings in 2016, also recently said is has seen an increased number of enrollees coming in and out of the exchange, especially through the special enrollment periods.

...Aetna Chief Financial Officer Shawn Guertin made similar comments in a Nov. 10 investors meeting at Credit Suisse. The phenomena that really we're seeing now is a lot more people coming in and out of the system, and in particular people coming in during a Special Enrollment Period and then staying for only a few months and dropping, is really part of what's draining the system, Guertin said.

U.S. health insurers Aetna Inc and Anthem Inc on Friday sought to reassure investors that their Obamacare businesses had not worsened after UnitedHealth Group Inc warned of mounting losses in that sector.

Aetna and Anthem said their individual insurance businesses, which include the plans created by President Barack Obama's national healthcare reform law, had performed in line with projections through October. Both backed their earnings forecasts for 2015.

A number of different factors came together to power Edwards' win. One is that Edwards, as a former Army Ranger with deep family ties to Louisiana state politics, had the right kind of biography to win in a red state. The other is that Vitter's rather unusual history with paid sex gave him the wrong kind of biography to win in any state. Add on to that the fact that the Louisiana Republican Party is divided and factionalized and the GOP has a firm grip on the state legislature, so some Republicans aren't exactly weeping to see Vitter lose.

Last but by no means least, the Louisiana economy is suffering from the global trend toward cheaper oil in a way that naturally helps challengers.

Given the one-two punch in the same 24-hour period, I titled the second entry "Has the Great Insurance Broker Purge begun?"

I was being partly tongue-in-cheek, but it appears that the answer to that question is, in fact, "Yep."

Insurance broker Josh Dickerson, who also gave me the heads up re. UnitedHealthcare and Phoenix, just forwarded a third "your services are no longer needed" letter from HealthSpan (an Ohio-based carrier) to their broker network...and this one has a slight twist:

Just a few hours ago, I was amused to note that HealthCare.Gov took my advice by adding a short explanatory message to one of the first screens you see on the window shopping tool. While a seemingly tiny thing, this one simple improvement could potentially increase 2016 enrollments by a few thousand people (or, at the very least, make the process slightly less annoying for many more).

Anyway, that alone would've been enough to make my day...but then, just moments ago, the CMS division sent out the following list of Proposed Improvements for the 2017 Marketplace (ie, for next year):

The Centers for Medicare & Medicaid Services (CMS) today issued the proposed annual Notice of Benefit and Payment Parameters for 2017, governing participation in the Health Insurance Marketplaces. The proposed rule seeks comment on proposals that will provide continued choice and competition for consumers, and a vibrant and growing market for affordable, quality health plans. The proposed rule seeks to improve the consumer experience, both when individuals shop for health insurance and when they use it.

Late last night I posted a quick walk-thru of the all-new 2016 HealthCare.Gov Window Shopping tool. For the most part, it's a major improvement over the 2015 version (which itself was, of course, a massive improvement over the buggy, 78-screen original version launched for 2014 open enrollment).

However, there are a few improvements which can always be made, and for me, one of the biggest ones is right at the beginning. Immediately after entering your Zip Code, the very first question which pops up is "Are you enrolled in a 2015 Marketplace health plan?"

Aside from the fact that some people may not even know whether or not their current plan is "through" the ACA healthcare exchange or not ("Marketplace" is a pretty generic term, after all...) the problem is that if you choose "Yes", here's what pops up:

On October 1, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that for the first year of the three year risk corridors program, qualified health plan (QHP) issuers will pay charges of approximately $362 million, and QHP issuers have requested $2.87 billion of 2014 payments, based on current data for the 2014 benefit year. 1 Consistent with prior guidance, assuming full collections of risk corridors charges for the 2014 benefit year, insurers will be paid an amount that reflects a proration rate of 12.6% of their 2014 benefit year risk corridors payment requests.2 The remaining 2014 risk corridors payments will be made from 2015 risk corridors collections, and if necessary, 2016 collections.

"Get him out of my sight, Lou! I want him in town, though. He's still under contract. I want you in town, Fink...and out of my sight." --Barton Fink

The big ACA story Thursday morning was about UnitedHealthcare announcing that while they're still available across half the country for 2016, they may drop out of the ACA exchanges next year (2017). Furthermore, they're cutting their marketing/promotional efforts for the exchanges and, in an additional exclusive tidbit from myself, they've also informed their commission-based brokerage network that they'll be slashing their commission rates by as high as 80% for exchange-based enrollments. On top of that, they've even supposedly deliberately disabled various database tools used specifically by brokers to assist in helping people sign up for UHC policies through the exchanges.

UPDATE: I've gotten the OK from my source, Joshua Dickerson, to give him a public should-out for the heads up.

Regular readers know that although I do spend a lot of time updating this website, I do still have to do my day job running a website development firm. As a result, I'm simply not able to keep up with every healthcare-related hot tip which comes my way.

Over the past few months, we've seen an acceleration of changes in the health insurance market. UnitedHealthcare is continually evaluating all aspects of the evolving exchanges so that we can provide coverage options that best meet consumers' health care and financial needs.

Remember a few weeks ago when the right-wing Heritage Foundation published a study which tried to claim that only 3% of the net increase in Americans with healthcare coverage due to the first year of the Affordable Care Act exchanges was via private individual policies, with a crazy-high 97% of it allegedly coming from Medicaid expansion?

Remember how the only basis for this argument was an extremely shaky claim that employer-sponsored insurance had supposedly dropped by 4.5 million people from 2013 to 2014 (which supposedly cancelled out all but 260,000 of the private policy gains)??

Covered California has a slightly annoying policy (they did this last year as well) of not publicizing how many current QHP enrollees have renewed their policies (or switched to a different exchange-based one) until well after the December deadline has passed.

As of Nov. 17, approximately 6,000 new enrollees had elected to purchase a family dental plan at the time of enrollment. In addition, more than 27,000 current members had chosen to purchase a family dental plan at the time of renewal.

Covered California also announced Wednesday that more than 34,000 new consumers had selected a health insurance plan through the exchange since open enrollment began.

By my reckoning, total national QHP selections should hit around 1.33 million by the end of Week Two, of which around 1.07 million should be via HealthCare.Gov. I the expect around 1.9 million in Week Three, around 2.4 million by Thanksgiving, and then start ramping up to around 6.3 million by the 12/15 deadline for most states.

The second week of Open Enrollment for Marketplace coverage saw millions more Americans exploring their health insurance options by calling the call center, attending enrollment events, or visiting HealthCare.gov or CuidadoDeSalud.gov.

Minnesota only accounted for 0.5% of total QHP selections for 2015; extrapolated nationally at the same ratio, this would suggest around 1.37 million QHPs nationally through yesterday...which is a little lower than I'm currently estimating, but in the right ballpark.

This really shouldn't be considered profound or prescient, but the entire concept of of "free market competition" only works as intended if the customers actually shop around and compare their options. If people just ignore changes in the offerings available and stick with what they have regardless of the new options available, the "competition = better value" mantra collapses.

That's why I've been stressing the importance of shopping around on the ACA exchanges (or even off-exchange) so much this year. As I noted back in October:

Note: When reading any headline about Rhode Island, always keep in mind that with a total statewide population of just over 1 million, any ACA numbers reported will generally be pretty tiny.

A few days ago, I noted in my entry about Rhode Island's #OE3 Week One enrollments that they had seemingly managed to chalk up a whopping 30,000 people in the first week, nearly as many as their total #OE2 enrollment for 2015. The obvious reason for this, however, is that unlike every other state which is holding off until mid-December to automatically renew current enrollees, Rhode Island has decided to "front-load" the process by doing so up front. In practice, this doesn't really change anything because those current enrollees can still go into their account before 12/23 and switch to a different plan if they wish...or to cancel the renewal altogether if they choose to drop out of any exchange plans next year.

As a result, the 30,680 QHP figure in RI is extremely skewed and can't be used to estimate/project any other state data. It also means, as I said at the time:

Dr. Franklin faces an ethical dilemma when the parents of a dying child refuse to let him operate for religious reasons. Their son is suffering from a chronic respiratory ailment and will die soon. It can be cured with surgery; however their religion prohibits surgery (believing that cutting into a body will release the spirit, reducing the body to something worse than death—it is something only to be done to food animals). Franklin's associate Dr. Hernandez attacks their beliefs, but Franklin reprimands her, telling her that they have to work with the parents, not against them.

Ever since Texas passed HB2 in 2013, the omnibus abortion law at the heart of a pivotal case the Supreme Court will review early next year, more than half of the state's 41 abortion clinics have been forced to close. As these closures have mounted, advocates in the state have worried that the decline in abortion access could lead to a rise in the number of women trying to terminate pregnancies by themselves.

But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.

“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”

DENVER — Between Nov.1 and Nov. 15, more than 21,000 Coloradans enrolled in health coverage for 2016, either in private health insurance purchased through the state health insurance Marketplace or in Medicaid, or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.

“We are very pleased with the number of initial sign-ups during the first two weeks of Open Enrollment,” said Connect for Health Colorado® CEO Kevin Patterson. “But I want to urge everyone to not put off their 2016 health insurance coverage. New customers and renewing customers have a number of choices to consider. I encourage all of our customers to review their options and complete their enrollment before the last-minute rush.”

I know nothing about the military, but I'll say this: For all the screaming and hollering by the Republican presidential candidates over everything that President Obama is supposedly doing wrong when it comes to battling ISIS (or ISIL, or Daesh, or whatever the hell their name is this week), according to this story out of the L.A. Times, it sounds an awful lot like every one of their plans pretty much consist of slight modifications to what the Obama administration is already doing:

From the intensity of their rhetoric, the candidates seeking to replace President Obama might sound like they have policies for combating the Islamic State militants that are dramatically different from his. So far, they don't.

At a news conference Monday, Obama made clear that in the aftermath of the Paris attacks that Islamic State claimed to mastermind, he intends to stick with his plans.

Nov. 15--As a licensed health insurance agent, Sam Ross was used to seeing changes slipped into customers' plans during open enrollment season.

But he was surprised this month when he opened a letter from Highmark. The 60-year-old Southmont man discovered that his current plan, the Highmark Shared Cost Blue PPO 1000, which was eligible for premium tax credits on the Health Insurance Marketplace, was being discontinued -- and that he automatically would be enrolled in another plan not on the marketplace if he didn't take action before Dec. 15.

A Highmark representative said the company mailed letters to some customers -- though he wouldn't say how many or provide a list of plans being discontinued.

The company is "mapping" some customers on plans that are being discontinued into new plans, he said.

Factoring in the tax credit, the new plan would have cost Ross $481.02 more a month. It didn't come close to offering similar coverage, Ross said.

Before the Affordable Care Act, insurance companies could use medical underwriting, along with the threat of rescission, to tell whether a new policy applicant was being truthful or not about their smoking status. Under the ACA, of course, it's illegal for insurance companies to ask any questions about your medical history or pre-existing conditions which you might have...with a few exceptions, the main ones being a) whether anyone on the policy is pregnant and b) whether anyone on the policy is a smoker (hopefully not the same people!).

I was out of town over the weekend, visiting Alabama for my niece's Bat Mitzvah; then, when we got back it turned out our broadband connection had gone out (I'm currently at the library while waiting for the AT&T guy to show up).

In any event, a lot of big news happened over the past few days. The biggest non-healthcare-related stories, of course, were the horrific ISIS attacks in both Beirut (over 40 killed, over 200 wounded) and Paris (over 120 killed, over 300 wounded). My deepest sympathies to the people of Lebanon and France.

Alabama's Republican governor says he is considering expanding Medicaid under ObamaCare in his state.

"We are looking at that,” Gov. Robert Bentley said Thursday, according to The Associated Press. “We have not made a final decision on that yet, exactly how that would work.”

Bentley indicated that expanding Medicaid, the government health insurance program for the poor, could help get more doctors into rural parts of the state.

"I am concerned about the plight of the working poor,” he said. “If doctors are not paid for seeing those patients, doctors will not go to rural Alabama, because you can't expect a doctor to go to rural Alabama and lose money.”

The Republicans in two dozen states thought they were playing smart politics (with people's lives, but screw them, right?) when they denied Medicaid expansion, but this has since blown up in their faces, and has now become a potent issue for Democrats in several GOP-held states. I think I know why they thought this...and why it didn't work out the way they figured.

As far as I can tell, the Republican mindset was this: Poor people don't vote. Therefore, screwing over poor people = brownie points from the GOP base without any potential downside.

However, I think they forgot something important: Regular Medicaid might only apply to poor people, but the Medicaid expansion provided for by the ACA applies to many lower-middle class people...and they do vote (at least in greater numbers than the "dirt poor" anyway).

Of the 543,000 people who submitted applications and chose plans, 34% were new customers and 66% were re-enrolling, CMS said. Nearly 1.2 million people submitted applications for coverage.

Health and Human Services Secretary Sylvia Mathews Burwell called the numbers a "solid start." But she warned that It’s difficult to directly compare this year to last year's start of open enrollment as it started on Nov. 15 last year.

"We know from past experience that people are deadline driven, so we don’t expect to see deadline effects for a few weeks," she said.

Massachusetts' #OE3 enrollment numbers have to be handled a little carefully. Unlike most exchanges which mainly report the number of Qualified Health Plan (QHP) selections (ie, placed in cart & checked out), the Massachusetts Health Connector is very careful to specify how many of those are actually entered into the system and have paid their first monthly premium.

More than 57,000 people enrolled in health coverage through MarylandHealthConnection.gov during the first nine days of 2016 open enrollment, more than double the enrollment traffic during a comparable span a year ago.

Of the 57,213 who enrolled from Nov. 1 through Nov. 9, 10,867 were in private qualified health plans; 45,402 were in Medicaid and 944 were in stand-alone dental plans. The large Medicaid total included previous Medicaid enrollees who were in Maryland's former legacy system and were "redetermined" into the new web-based system.

Assuming roughly a 25% QHP selection increase this year (at least, that's what I'm assuming), that would translate into around 750K nationally, 570K of which would be via HealthCare.Gov, but I'll be a little cautious and drop it back to at least 720,000 QHPs in Week One nationally, 550,000 via HealthCare.Gov.

In the first week of the third Open Enrollment, more than 540,000 people selected a health insurance plan through the HealthCare.gov platform and more than 1.15 million consumers were included on applications submitted to the Marketplace. Even more signed up through their State-based Marketplaces.

[assuming that everyone currently enrolled sticks with their current policy next year], no matter how I slice it, the national weighted average increase for 2016 seems to be somewhere between 12% - 13%.

My attempt to boil down the overall, weighted-by-market-share, national average 2016 individual market rate increases into a single percentage figure has received a lot of attention over the past few weeks, including not one but two citations from Paul Krugman of the New York Times, feature articles from Bloomberg News and the Huffington Post, and even a partly-mangled version from the right-wing Daily Caller.

I'm not name-dropping for the heck of it here; my point is that I've been a little jumpy about that particular projection (12-13% overall) getting so much attention because I honestly had no clue how accurate it was.

In late September, the handful of CEOs leading Affordable Care Act-funded consumer operated and oriented plans traveled to Denver in search of answers.

The past year had been a difficult one. Their companies were struggling, awash in red ink and facing a mounting list of operational challenges. A few co-ops had already shut down, and regulators were circling several more. The fledgling health insurers needed more support from the Centers for Medicare & Medicaid Services if they were going to survive. Most importantly, they needed a lot more money.

Wow! After 3 1/2 Republican debates spanning upwards of 13 hours or so (7 debates, actually, if you include the "Kiddie Tables" separately), a few hours ago FOX Business Channel's Maria Bartiromo finally asked a substantive question regarding the Affordable Care Act, and Carly Fiorina was the first Republican candidate to actually say anything substantive about it (note: I'm not counting the boilerplate "we need to repeal/replace Obamacare!" bits tossed on the plate like croutons by Marco Rubio and Jeb Bush).

The good news (relatively speaking) is that the 200,000-odd New Yorkers currently enrolled in about-to-be-defunct Health Republic NY Co-Op policies have been given an extra 15 days to find a new insurance provider (11/30 instead of 11/15), and that those who don't do in time will be automatically enrolled in a temporary (1-month only) policy with someone else to at least ensure coverage to tide them over through January. The temporary policy may or may not include their preferred doctors/hospitals, but it's better than having no coverage at all during the December gap period, anyway.

Dennis Blackburn has this splintered self-interest. The 56-year-old mechanic hasn’t worked since he lost his job 18 months ago at a tire company that supplies a diminishing number of local coal mines. “The old guy had to go home,” Blackburn says of his layoff.

He has a hereditary liver disorder, numbness in his hands and legs, back pain from folding his 6-foot-1-inch frame into 29-inch mine shafts as a young man, plus an extra heartbeat — the likely vestige of having been struck by lightning 15 years ago in his tin-roofed farmhouse.

According to 8 of the state-based exchanges (CO, CT, DC, ID, MD, MA, MN & WA), effectuated enrollments as of the end of September were up 2.7% from the end of June (or down just 0.1% if you disregard Massachusetts, which has some special circumstances).

However, the quarterly financial reports from 8 major insurance carriers claim that private exchange enrollments in September were down around 7.9% since the end of June.

This discrepancy continues with the release of the Colorado exchange's October enrollment report. As you can see, when you add up the effectuated tax credit enrollees (APTC/CSR) (78,670) and the full-price enrollees (64,485) as of October 31st, they total 143,155 people.

Things have been changing rapidly in the ongoing Health Republic of New York saga, and as recently as last night each development seemed to make the situation worse...but a few hours ago, Politco New York reporter Dan Goldberg posted a new story which indicates that the powers that be finally have some positive news:

In an effort to head off a potential health insurance disaster, state officials on Sunday announced a series of steps to protect roughly 200,000 customers who are set to lose their health coverage, and promised to investigate the company behind the crisis.

...And those were just the customers who were aware of the change. No one could say for certain how many were unaware they were about to lose their coverage, and other insurers operating on the exchange expressed concern that the customers most likely to pick a new plan were the ones most likely to be sick, a scenario of adverse selection that few companies were prepared to handle.

Last year, to my everlasting joy, the HHS Dept. finally started issuing not just big, bulky monthly ACA exchange enrollment reports but also began issuing simple weekly enrollment "Snapshot" reports, giving just the "top line" number of people who had selected Qualified Health Plans (QHPs) in the preceding week. The first few weeks they only gave out the national total, but a few weeks in they started breaking it out by state (and, eventually, even by major metropolitan areas).

The irony here is that if they had started doing exactly this in the first place back in 2013 (just the QHP tally per state on a weekly basis, nothing more than that) I almost certainly never would have bothered tracking ACA enrollments myself, and thus this website/project never would have started at all.

For the third time around, I'm guessing the President has something similar in store for the final lap in mid-January (remember, the deadline is 1/31/16 this year), but to kick things off, he's annouced an interesting new promotional effort:

White House launches Obamacare sign-up competition

As open enrollment season on HealthCare.gov begins, President Obama is introducing a contest meant to motivate Americans to sign up for health insurance coverage through federal and state exchanges.

Just this morning I posted some significant updates in the ongoing, increasingly messy saga of Health Republic of New York, one of the ACA-created Co-Ops which is being shut down due to severe financial issues (partly due to the Risk Corridor Massacre debacle, but other reasons as well).

Once again, the short version is:

Most of the Co-Ops which are being shut down are at least able to cover their policies through the end of December, giving their current enrollees plenty of time to shop around and switch to a different insurance carrier. This was supposed to be the case for Health Republic of NY as well.

However, on October 30th, there was a surprise announcement by the NY Dept. of Financial Services (which includes insurance regulation) that instead of December 31st, the HRoNY policies are being yanked effective November 30th. Furthermore, current enrollees have only until November 15th to find a replacement to tide them over for December.

While one month may not sound like a big deal, it's a huge problem for at least some of the 200,000-odd people currently enrolled via HRoNY (note: I thought this number was down to 166K, but may be mistaken about the figure).

It's a major problem for some enrollees who are undergoing chemotherapy, for instance, or have other recurring medical services/treatments (many of which are expensive) which can't be "paused" for 31 days.

I wrote a couple of posts last week about the ongoing Health Republic of New York Co-Op meltdown, which has quickly gone from being just-another-Co-Op-closure to a complete disaster for up to 166,000 New York residents, primarily because unlike the other Co-Ops which are at least covering their existing enrollees through the end of December, Health Republic is now having the plug pulled out at the end of November, which gives current enrollees just 8 days to scramble to find new coverage for the last month of 2015.

This was made worse by the fact that the November 30 cut-off wasn't even announced until October 30, and even then, the powers that be in the NY Dept. of Insurance, NY State of Health exchange and Health Republic itself didn't appear to treat this development with any particular sense of urgency. I mean yes, they posted notices about it and supposedly sent out letters to all 166,000 people, but an awful lot of those people didn't appear to have received those notices as of a few days ago. Hell, until a day or two ago the NY State of Health website didn't even have anything posted about the 11/30 cut-off at all.

Well, I've been screaming bloody murder about the situation, as have others, and it seems to be getting some butts moving...but I'm not sure how helpful any of it will be.

Unlike the federal exchange (HealthCare.gov) and many of the state-based exchanges which have experienced massive technical problems to some degree or another over the past two years (Oregon, Nevada and Hawaii have gone kaput; Massachusetts & Maryland had to be completely rebuilt; Vermonts is still iffy), the Kentucky ACA exchange website, aka "kynect" (lower-case intentional), has been chugging along smoothly since Day One on October 1, 2013. It's fully self-sufficient, well known and trusted by Kentuckians, and has been an amazingly successful venture in general.

Speaking in his first public comments since he was elected governor of Kentucky on Tuesday, Matt Bevin repeated his pledge to dismantle kynect, the state’s health insurance exchange that has been hailed as a national model.

“My intent is to have it wound down by the end of next year,” Bevin said of the online service people use to shop for health coverage or determine whether they are eligible for Medicaid under the Affordable Care Act.

NOTE: I am very much aware that simply "mashing up" 2 different surveys and splitting the difference is not a statistically professional way to do this, but it's the best I can do for the moment.

Back in July, after Gallup released their quarterly survey finding the U.S. uninsured rate to have dropped to 11.4% for adults 18 and older, I posted a more detailed graph which also separated out people caught in the Medicaid Gap as well as uninsured Undocumented Immigrants (who aren't eligible for either the ACA exchanges or Medicaid/CHIP, except for children in California...and I presume the new CA law doesn't start until January). Here's what the chart looked like at the time:

Health insurance premiums will increase on average 7 percent in Colorado in 2016, according to statistics compiled by the state division that reviewed and approved plans for the coming year.

...Consumers who purchased through Connect for Health Colorado, the state health insurance exchange, in 2015 who aren’t eligible for tax credits will see an average increase of 12 percent if they simply renew their current plan for 2016.

Look, the later part of the article talks about the form in question itself, IRS Form 8962, being overly complicated, and perhaps it is. It's 2 pages, and while it's certainly not as bad as some other federal tax forms, I can definitely see it being intimidating to those who are used to just filling out the 1040-EZ form, as I did years ago. Comic strips and sitcoms have used the "Taxes Are Hard!!" meme as comedic fodder for decades. So no, I'm not going to berate anyone complaining about the form being difficult to fill out.

HOWEVER, complaining about having to file a tax return AT ALL? You're receiving thousands of dollars in tax credits and you didn't think you'd have to fill out a tax form in order to prove your eligibility?

WASHINGTON, D.C. -- The uninsured rate among U.S. adults aged 18 and older was 11.4% in the second quarter of 2015, down from 11.9% in the first quarter. The uninsured rate has dropped nearly six percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect.

...Again, it's safe to assume that this has gone down as well, although probably not as dramatically as for adults. A similar 36.7% drop would be around 2.2 million children (taking population increase into effect), but even half of that would still lop a good million children off the uninsured tally...or an additional 0.3% of the total population.

In other words, it's likely that the actual uninsured rate for the entire U.S. population (all 320 million of us) is down to around 28 million adults + 4.9 million children, around 33 million total...or 10.3% of the entire population.

Oh, wait...no, it's actually just The Graph, officially returning for the third go-around.

I know, I know; you're looking at this and saying "How the hell is he getting 230,000 nationally when he's only confirmed around 8,700?"

Simple. In fact, as I explained earlier today, it's entirely possible that the national total is much higher than 230K already--it could potentially be up to as high as 800,000 or more already. Here's a simplified explanation:

The dozen collapses will disrupt insurance for 740,000 individuals and small-business employees, who are being instructed by state and federal officials to choose new plans in time for them to take effect in January. In New York state, the window is narrower. Government officials have moved up the closing date of the New York Health Republic co-op, the nation’s largest, giving its more than 200,000 members just two weeks to select different coverage before it shuts down at the end of this month.

Although it lost money in 2014, New Mexico Health Connections is “financially very strong” with strong cash reserves, CEO Martin Hickey said Wednesday. In fact, the co-op expects to greatly expand by picking up consumers who had been insured with Blue Cross Blue Shield New Mexico on the state health exchange. Blue Cross is not offering individual insurance policies on the exchange for 2016.

“Our competitors don’t want to believe it necessarily, but we’re financially healthy,” Hickey said. “We’re going to be here for a very long time.”

The federal exchange, HealthCare.gov, opened for business Sunday and will serve 38 states that rely on the marketplace. California’s state-run exchange is launching a 38-stop bus tour to get the word out about signing up and re-enrolling for coverage. Minnesota’s exchange had a couple hundred people sign up in the first hour after opening in the morning with no signs of any technology problems.

“We’re not expecting a whole lot of enrollment because it’s a 60 degree day on a Sunday, but so far so good,” said Shane Delaney, a spokesman for MNsure. The state exchange has hundreds of brokers and navigators geared up to assist consumers.

One of the arguments Kentucky Governor-elect Matt Bevin has made in favor of killing off the wildly successful, smoothly-operating kynect state-based ACA exchange has been that doing so would "save Kentucky money". The idea is that by shifting everything over to the federal exchange at HealthCare.Gov, the state of Kentucky would save the cost of operating their own exchange.

In one sense, this is true; kynect is currently supported by a flat 1% charge for all premiums on all individual policies sold in Kentucky, both "inside and outside of the marketplace." In other words. whether you enroll in a individual policy either via Kynect or directly through the insurance carrier, they're tacking on a 1% surcharge to your premiums to pay for the exchang to operate. So, yes, dropping kynect would also stop that 1% fee from being charged.

I finally brought my 2016 Average Rate Hike project to a close a couple of weeks ago, coming to the conclusion that nationally, weighted average rates on the individual market are going up around 12-13% overall. With Open Enrollment having kicked off, I'm pretty swamped and don't have the time to revisit every state to update/correct every piece of missing or erroneous data.

Health insurers requested an average rate change of 5.6 percent for their 2016 individual health plans, but the Office of the Insurance Commissioner approved 3.9 percent after a review. Actual premium amounts will vary based on the plan someone selects, their age, how many people are covered, and where they live.

If you're one of the ACA-created CO-OPs which isn't going out of business, I have to imagine that it's a tough enough job convincing current enrollees to stick with you right now, much less convincing new customers to give you a shot. I mean, look at it from the perspective of someone needing coverage; they're probably gonna be jumpy about signing up with one of the CO-OPs, fearing that they might be shut down just a few weeks/months later, right?

Well, for Common Ground, the Wisconsin CO-OP, which isn't going out of business and which is accepting both renewals as well as new customers right now, this can't be helping matters (from an email just sent to me today):

Copy of email sent by Common Ground Healthcare Co-op (Wisconsin)....

November 3, 2015

If you called the Marketplace and were told that our plans are not available for 2016, you were given INCORRECT information.

Premiums are slated to rise steeply next year for health plans across the board. Yet almost half of voters who have health coverage under Obamacare say they will keep their current plan through 2016, according to a new Morning Consult online poll.

The findings could be a worrying sign for the Obama administration, which is urging people who buy their insurance on state or federal exchanges to shop around for new plans to avoid premium increases. But the results could also be seen as a positive sign for Obamacare, generally. Half of enrollees are satisfied with their current plan and another one-third are comfortable enough with the online exchanges to look for cheaper coverage, as intended.

It appears that East Lansing-based Consumers Mutual Insurance of Michigan could wind down operations this year as it is not participating in the state health insurance exchange for 2016.

But officials of Consumers Mutual today are discussing several options that could determine its future status with the state Department of Insurance and Financial Services, said David Eich, marketing and public relations officer with Consumers Mutual.

Last month, HealthCare.Gov announced that they'd be including several handy new tools in their Window Shopping database. Some are working already, but a few were held back due to not having all the kinks worked out yet. One of those is the much-needed "In Network" tool, to make sure that your preferred doctors, hospitals, specialists etc. are all covered by whichever policy you're interested in for 2016.

Beginning today, HealthCare.gov is piloting a new beta feature that allows consumers to search plans by their preferred provider or health facility. Some consumers will be part of a pilot that allows them to use the beta Doctor Lookup feature as they compare their coverage options in window shopping or when selecting a plan.

MNsure, the Minnesota ACA exchange (which isn't included in the HC.gov analysis above, of course), just posted their own independent analysis of their 2016 rate offerings, and while the picture is pretty ugly for current enrollees who don't shop around, it's actually pretty damned good for those who do so:

This is a good sign, believe me. HOWEVER, it's important to remember that applications are NOT enrollments, and in fact are not even plan SELECTIONS, which is the main number that I'm keeping track of here.

An application simply means that someone either created an account and filled out their personal info (name, address, age, social security number, etc) or that someone with an existing account updated their personal info (income changes, new baby, whatever) and re-submitted it to the HC.gov website.

Every year, plenty of people (including reporters who should know better) confuse applications with plan selections.

I'm not name-dropping for the heck of it here; my point is that I've been a little jumpy about that particular projection (12-13% overall) getting so much attention because I honestly had no clue how accurate it was.

HELENA, Mont. (AP) — Montana will become the 30th state to expand its Medicaid program after federal health officials on Monday approved provisions that include requiring beneficiaries to pay premiums that amount to 2 percent of their income.

Gov. Steve Bullock announced the Centers for Medicare and Medicaid Services' approval of the federal waiver needed for state officials to start enrollment this fall and begin coverage on Jan. 1.

The governor's office has said 70,000 people or more would be eligible for coverage under the expansion, but legislative fiscal analysts predicted about 45,700 would actually participate over the next four years.

Actually, if the past 2 years of Medicaid expansion in the other 29 states are any guide, Montana will probably hit 50-60K easily within the first year. Many other states ended up maxing out by the end of 2014.

I've mentioned tomorrow's Kentucky gubernatorial election, and the fact that Republican candidate Matt Bevin is not just a staunch opponent of the ACA (not exactly a shocker) but that he's repeatedly stated that if elected, he'd repeal the state's implementation of Medicaid expansion, which is currently providing healthcare coverage for about 400,000 people (around 350K enrolled in 2014, and another 50K or so this year).

However, I was a bit shocked this morning when I realized that I've only mentioned the KY race in passing via my "Short Cuts" link roundups.

With the election just one day away and my plate filled with other OE3-related stuff, I don't really have time to do a full write-up. Fortunately, John Oliver of Last Week Tonight has done an excellent job of explaining the whole situation (there's actually three state elections tomorrow where Medicaid expansion is theoretically an issue, but Kentucky is the only one where it's at risk of being taken away). Watch the whole thing:

I've given a lot of interviews to various media outlets over the past 2 years. Most of them are fairly neutral ideologically; some are obviously left-of-center; and once in a blue moon, I'll even provide input to a right-of-center outlet which seems to be intellectually honest about how they present themselves.

The thing is, while Investor's Business Daily is mostly full of shit, they do have one honest reporter by the name of Jed Graham, who I actually have a lot of respect for. For instance, just yesterday he wrote a story about the same topic (how much have effectuated exchange QHPs dropped since June) in which he cites my work properly:

The start of open enrollment on the state's online marketplace for health insurance went smoothly Sunday, officials said, with almost 780 people signing up by late afternoon and many others calling for information or meeting in person with professional advisers.

The Maryland health exchange launched free of the technical problems that disrupted enrollment in the first enrollment season beginning in the fall of 2013.

Performance improved in 2014. Consumers this time were promised a user-friendly website, a simpler application and better access to knowledgeable brokers to help them choose plans, exchange officials said.

Those moves were expected to help the state reach a goal of signing up 150,000 people in private plans, up from 115,000 last year.

"It was a good first day," said Andrew Ratner, exchange spokesman. "Especially being a Sunday."

By 4 p.m., 779 people had enrolled, including 461 in private plans and 136 in Medicaid, and 182 in dental plans.

The New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the Centers for Medicare and Medicaid Services (CMS) today announced additional actions regarding Health Republic Insurance of New York (“Health Republic”) and a transition plan for Health Republic customers.